Makindo Medical Notes

Related Subjects: |Respiratory Failure |Non invasive ventilation (NIV) |Intubation and Mechanical Ventilation |Critical illness neuromuscular weakness |Haemodialysis |Dobutamine

Etomidate was withdrawn as an agent for continuous intravenous sedation in the intensive care setting as it was shown to increase mortality. Subsequently, this was found to be attributable to inhibition of 11-hydroxylase activity and adrenocortical suppression

About: Always check the BNF link here

• IV anaesthetic agent and Induction agent
• Useful in cardiovascular unstable patients
• Check BNF or equivalent for UpToDate prescribing advice

Mode of action

• A carboxylated imidazole compound that was introduced in Europe in 1972.
• Short acting IV anaesthetic agent
• It inhibits cortisol synthesis by inhibiting CYP11B1 with 11-beta hydroxylase activity, and cytochrome P450 at high concentrations.

Indications/Dose

• Etomidate 0.15-0.3 mg/kg slow IV over 30-60 seconds
• Etomidate (Elderly) 0.15-0.2 mg/kg slow IV over 30-60 seconds
• Onset 5-15 seconds and recovery 5-15 minutes
• Max amount per dose 60 mg

Interactions

• See BNF

Cautions

• Shock, adrenal insufficiency, acute porphyria
• Cardiovascular disease; elderly; fixed cardiac output; hypovolaemia

Contraindications

• See BNF

Side effects

• Apnoea, hypotension, nausea, skin reactions, movement disorders
• Adrenocortical suppression, less rise in ICP
• Reduces cerebral blood flow and oxygen demand

References

• Etomidate BNF